I am contemplating S1-L5 lumbar fusion. Outcomes thoughts

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I am a 79- year-old male and had the L3, L4, and L5 fusion done in January 2022. The surgery was done in two stages. ALIF and XLIF on January 31, 2022 and PLIF the next day, on March 1, 2022. Owing to the "brittleness" of the iliac artery and vein which could not be moved, S1-L5 fusion was not done. Attached are pictures three months after the surgery. I am sure you will look-up the acronyms and find the read very interesting. I am living at a pain level of 0 to 1 without painkillers. My surgeon is a saint for performing this miracle and giving me back a quality of life which I am enjoying! I have been following the PT regimen at home since the surgery,

A little goof up! The surgery was done on February 28, 2022,
and the X-ray was taken fifteen days after the surgery not after 3 months. Is this on-set of dementia?

Hello I read your post. It’s just a one level S1L5 fusion due to DDD and severe facet arthritis. The rest is motion preserving. Surgeon is a top doc in Germany with motion preserving technology not yet available in USA.

Yeah, sorry I wrote that post in terrible pain so i came back and deleted. I'm guessing that being in Germany gives you more options. Pain stuff in the US is SO messed up. Drs just dont show any respect for patients way too often. Esp related to pain. I had a dr want me to.see a pain dr for 4 days of postop pain meds. I mean really, you are supposed to do a rotator cuff on tylenol? Its crazy over here.

I was actually reading today about fusions and skiing. Its much better than I thought! Sorry you read it before I deleted. I shouldn't post in that frame of mind. Best of luck.

Hi skijag,

I don't know the severity of your problem. I had spinal stenosis (narrowing of the spinal canal), ruptured disc at L5/S1, scoliosis (crooked spine), and some L-discs sliding over each other, along with severe disc degeneration. This caused pressure on my sciatic nerve causing pain in my hamstrings, buttocks and calves. I could not stand for more than a minute.

The first surgeon would only do fusion at L5/S1 and probably L5/L4 too. I got a second opinion and that surgeon did a laminotomy at L4, L5, and S1 and removed the ruptured disc material as well as some arthritic spurs. No fusion. Laminotomy is the least invasive spine surgery, as only a small amount of vertebra is removed. This created more space for the sciatic nerve, relieving the pain in my leg.

That was 10 years ago and now I'm almost 70 and in the gym everyday. I do extensive work for my core muscles and work with a trainer. I take a spin class 4 or 5 times a week and also use an indoor rower. My new surgeon tells me my strong core is protecting me from surgery.

So make sure fusion is the only alternative. As my surgeon told me, fusion is always available if I was willing to first try the laminotomy first. It worked, so far...... Everyone is different of course.

All the best to you. Joe

Hi BeBold, and thanks for your comments.

We have to be very selective in choosing Drs and in this case, ortho surgeons. We recently moved and I had to find new Drs. I'm almost 70 and have had two successful knee replacements.

I look for surgeons with good med school and/or residency pedigrees. Mayo and Cleveland Clinic are my favorites. Then I look for the surgeon to be in his/her late 30s to late 40s. These Drs are still young, ambitious, and current on surgical/medical practices.

That's how I found my knee surgeon and he then referred me to my spine surgeon and shoulder surgeon. I think all of them are in their mid to late 30s. All of them view surgery as a last resort. And they are skilled so I don't have to worry about pain management. I follow their lead and it has worked.

All the best to those of you looking for answers to your ortho problems. You can find quality help.

Joe

Thank you for the welcome Jennifer. Glad to be here.
I have had 3 major orthopedic surgeries over a span of 25 years. I don't remember the exact recovery period for my spinal surgery. It might have been a bit longer. I do remember my coworkers were surprised to see me back within a month.
To make a long story short, I must say the stiffness on my lowerback is still with me along with a compromised range of motion , although not as intense. But this could have been due to my hip replacement ten years after my spinal surgery. (I am a "bionic" woman as I can never pass the "beep" at airports.)
Sometimes I do wonder if my active lifestyle caused trauma to my bones and joints. Not everyone is cut to play intensive sport like tennis. I give a lot of admiration to athletes like Federa, Nadal, Williams etc . They certainly work hard and they are highly gifted, especially their bones and joints.

Mary I take it you had fusion surgery. Which vertebra were fused?

The stiffness you describe is what scares me about fusion. I've avoided it by 1) having a laminotomy at S1/L5/L4 10 years ago to reduce stenosis and ease pressure on my sciatica and to remove a ruptured disc fragment, and 2) working on my core muscles every day and keeping my weight down. So far, so good.

I have a new surgeon now, and he has encouraged me to stick with the core work. I have stenosis, scoliosis, degenerative discs and vertebra, and some lumbar vertebra that slide over the vertebra below, I forget what that is called. It's a mess and he said if he had to operate, I'd have to have at least two vertebra fused.

I'm not afraid of orthopedic surgery - I've had both knees replaced with great success and my shoulder is next. But spinal fusion just scares me. Maybe the techniques now are better than the past.

Anyway, I wish you all the best. Joe

Hi, I had two spinal fusions, one at L3-5 in 2000 and another at L5-S1 in 2005. Before both surgeries I had had to use an electric wheelchair to get around and be able to do anything that required me to walk or stand. In the first one the surgeon had to rebuild the L4 vertebrae using a cage because it was so full of holes from Degenerative Disc Disease and in the second one he removed several bone spurs on the outside edges of several vertebrae and had to shave off bone that was growing into the spinal column space and trapping several nerves and blood vessels on two vertebrae. He also did several disc repairs due to ruptured discs in both surgeries. He also rebuilt a vertebrae in the second fusion but it wasn't in as bad a condition as the one that was done during the first one. There was enough bone left that he didn't need to cage it. Again due to DDD. I don't remember how long the recovery process was but I am glad that I had the surgeries. I haven't had any back pain other than a few twinges here and there when I have to stay in a bent over position for a while and then have to stand straight again since the fusions. I have almost full range of motion now and that's a big improvement over before the fusions. I have heard so many failed fusions stories since. I guess I'm one of the lucky ones in that they both were successful.